Healthcare providers’ perspectives on contributing factors to under-five mortality in a low-income setting: a qualitative study
1
Curtin School of Population Health, Curtin University, Perth, Australia
2
Department of Reproductive and Family Health , School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
3
School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
4
Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
5
School of Public Health, University of Adelaide, Adelaide, Australia
6
Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
7
Department of Midwifery, School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
8
enAble Institute, Curtin University, Perth, Australia
9
World Health Organization Collaborating Centre for Climate Change and Health Impact Assessment, Perth, Australia
10
Faculty of Medicine, Universitas Negeri Malang, Malang, Indonesia
11
Institute for Health Research, University of Notre Dame, Fremantle, Australia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Under-five mortality (U5M) remains a major public health challenge in low-income settings, where progress to address this burden has been limited. Quantitative evidence, largely based on maternal and child data, often overlooks contextual and systemic barriers to child survival. Understanding healthcare providers’ perspectives can help address these gaps and generate actionable insights for context-specific interventions to reduce U5M.
METHODS:
A descriptive qualitative study was conducted among healthcare providers in public health institutions of South Wollo Zone, Northeast Ethiopia, from 30 May to 3 July 2025. Participants were purposively selected with maximum variation across professional roles, work experience, and geographic locations. Data were collected through semi-structured in-depth telephone interviews. The transcribed data were uploaded to NVivo 15 and analysed using reflective thematic analysis.
RESULTS:
Twenty-one healthcare providers identified multiple interrelated factors contributing to U5M. At the individual level, factors included sociodemographic vulnerabilities, compromised maternal health-care practices, perinatal and neonatal risks, and inadequate childcare and nutrition. Interpersonal factors encompassed maternal death, maternal migration, limited partner support, marital dissolution, and low household income. Community-level factors involved drought, poor access to safe water, harmful traditional practices, and health-system barriers. Societal factors included poverty, rising cost of living, conflict, and weak policy implementation.
CONCLUSIONS:
U5M in this setting is driven by interconnected social, economic, and health-system barriers. Reducing mortality requires integrated, multilevel interventions that strengthen health systems, enhance maternal and child nutrition and care, and expand social and economic protection for vulnerable households. Further research incorporating community perspectives is needed to better understand factors influencing child survival.
Under-five mortality (U5M) remains a major public health challenge in low-income settings, where progress to address this burden has been limited. Quantitative evidence, largely based on maternal and child data, often overlooks contextual and systemic barriers to child survival. Understanding healthcare providers’ perspectives can help address these gaps and generate actionable insights for context-specific interventions to reduce U5M.
METHODS:
A descriptive qualitative study was conducted among healthcare providers in public health institutions of South Wollo Zone, Northeast Ethiopia, from 30 May to 3 July 2025. Participants were purposively selected with maximum variation across professional roles, work experience, and geographic locations. Data were collected through semi-structured in-depth telephone interviews. The transcribed data were uploaded to NVivo 15 and analysed using reflective thematic analysis.
RESULTS:
Twenty-one healthcare providers identified multiple interrelated factors contributing to U5M. At the individual level, factors included sociodemographic vulnerabilities, compromised maternal health-care practices, perinatal and neonatal risks, and inadequate childcare and nutrition. Interpersonal factors encompassed maternal death, maternal migration, limited partner support, marital dissolution, and low household income. Community-level factors involved drought, poor access to safe water, harmful traditional practices, and health-system barriers. Societal factors included poverty, rising cost of living, conflict, and weak policy implementation.
CONCLUSIONS:
U5M in this setting is driven by interconnected social, economic, and health-system barriers. Reducing mortality requires integrated, multilevel interventions that strengthen health systems, enhance maternal and child nutrition and care, and expand social and economic protection for vulnerable households. Further research incorporating community perspectives is needed to better understand factors influencing child survival.
| eISSN: | 2654-1459 |
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